| ObjectiveTo analyze the pressure change law of the tapered-cuff,and to explore the appropriate cuff pressure monitoring frequency by continuously monitor and compare the cuff pressure of the tapered-cuff endotracheal tubes and the cylindrical cuff catheter.Based on these,to explores a more reasonable method for fixing the conical cuff catheter by comparimg two fixations of the tapered-cuff catheter.And then forms a nursing specification for tapered-cuff endotracheal tubes to guide clinical work.Methods1.Eighty patients with oral tracheal intubation admitted to the emergency department of a large-scale top three hospital in Beijing from December 2016 to October 2017 were randomly divided into two groups.The intubation type of the experimental group was conical.In the control group,the intubation type of the control group was a traditional cylindrical cuff catheter,and the balloon pressure of the two groups of patients was continuously monitored.The changes of the cuff pressure over time were compared,and the frequency of cuff pressure monitoring of the tracheal cuff catheter was further explored.2.Seventy patients with tapered cuff catheters admitted to the emergency department of a large-scale top three hospital in Beijing from October 2018 to January 2019 were selected according to the principle of randomized control.The control group was treated with traditional fixation method.The improved fixation method was used to compare the time of normal pressure of the cuff in the two groups,the incidence of catheter displacement,the time taken to fix the catheter,the number of re-fixation within 24 hours,and the incidence of facial skin and mucous membrane damage.Results1.The cone-shaped cuff maintained normal pressure for less than the cylindrical cuff(P<0.05),the average pressure of the tapered cuff was smaller than that of the cylindrical balloon(P<0.05),the highest pressure fluctuation of the tapered cuff was greater than that of the cylindrical cuff(P<0.05).The lowest value of the cone cuff pressure fluctuation is smaller than the cylindrical cuff(P<0.05).2.There was no significant difference in the rate of cuff pressure between the 3.5h group and the 3h group(P>0.05).3.Logistic regression analysis of this study obtained swallowing action(Wald=6.173,P=0.013)and position change(Wald=5.062,P=0.024),which was a risk factor for abnormal cuff pressure in conical cuff catheter.4.The time to maintain normal pressure of the experimental group(4.386±0.631 h)was greater than that of the control group(3.700±0.531 h),P<0.01.The time taken for the fixed catheter in the experimental group(61.457 ± 6.572s)was smaller than that of the control group(95.686±9.812s),P<0.01.The number of re-fixed catheters in the experimental group within 24h(0.143 ± 0.355)was smaller than that in the control group(1.029 ± 0.822),P<0.01.The incidence of catheter transposition in the experimental group(44.3%)was lower than that in the control group(84.3%),P<0.01.The incidence of facial skin injury in the experimental group(8.5%)was lower than that in the control group(28.6%),P<0.05.Conclusions1.Compared with the cylindrical cuff,the pressure fluctuation range of the tapered cuff is large,and the time for the cuff to maintain normal pressure is short.In the clinical work,it is preferable to monitor the cuff pressure every 3.5 hours.The swallowing movement and the posture change are abnormal of the cuff pressure.Influencing factors should pay more attention to the cuff pressure management of patients with swallowing function.When the patient changes position,the catheter fixation should be strengthened.2.Improved catheter fixation method can make the tapered cuff pressure more stable,make the catheter fixation more secure,increase patient tube comfort,shorten the time used to fix the catheter,reduce the number of re-fixation,reduce the clinical workload.How to improve the fixture,in order to better protect the mucous membrane of the lips,further investigation is needed. |
